Metacam question & healing vibes for Fuzz, please

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PamsWarren

PamsWarren

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, Ontario, Canada
Fuzz saw the vet yesterday. He has some tiny molar spurs, which, despite the fact that the vet says they are tiny, they ARE causing him problems, so I will take him back tomorrow to have them removed.

He is also peeing blood. He had a bit of fresh blood on his foot yesterday at the clinic, but we were not sure where it came from. I now know. This morn, he was straining to urinate and clearly in pain. I gave him his dose of metacam, along with the baytril the vet prescribed for potential URI and some sub-q fluids...and he seems to be alot better at the moment. Nibbling on greens, grooming himself and peeing without straining. I am afraid, though, that the metacam will wear off and he will start to crash again. This happened last night...Fuzz was ok in the day (he was even humping Muffy :rollseyes), but by night, he was clearly in pain again.

Has anyone's vet ever prescribed metacam to be given 2x per day? I know that it is usually given 1x per day, but the information that I found on http://www.medirabbit.com says "sid? action lasts between 12-24 hours;" For anyone who has administered the drug twice per day, did you give the full dose morning and night? It is Sunday, so the vet who saw Fuzz yesterday is closed and the rabbit savvy vet at the other clinic I use(open 7 days a week) is on vacation this week. I always seek approval from my vet before administering any medication...but I don't want Fuzz to suffer. It was heart wrenching this morn watching him try to urinate. :cry1:

The vet did a blood draw yesterday, but I don't have the results back yet. She wanted to test his urine, but we couldn't get a urine sample. Hindsight being what it is, I should have asked for xrays, too, but I didn't. I will ask the vet about having xrays done, though, to check for sludge/stones.

Fingers crossed for my old guy :pray:. He is 11.5-12...but if it is true as they say that only the good die young, I almost expected Fuzz to live for ever :D (Just kidding about that last part...Fuzz is a lovely sweet boy. My favourite even. He's just always been one very, uh, busy rabbit :rollseyes)

PS...Fuzz is the rabbit in my avatar photo.
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I'm sorry Fuzz is poorly. I guess the good thing is that he needs a GA anyway, so hopefully getting the x-rays will be easy enough to do and not too much more strain on his poor body.

I've only ever used Metacam once a day, but yes, with some, I have found it wears off quickly. Hopefully someone else will know the answer though.

I hope, whatever the blood is, that it is easily solvable and that his spur burring goes well tomorrow.
 
Things always happen on a weekend .
Ideally it would be best to get him to a vet ASAP as another pain medication like tramadol may be more effective for his pain and less stressful on his kidneys. When you do give the metacam make sure that he is well hydrated as the drug is not easy on the kidney anyway.
I would guess that he has an bladder infection and that the vet decided to hold off on the x-rays hoping the present treatment would take care of the problem...

http://www.rabbitsonline.net/view_topic.php?id=12052&forum_id=10
 
Hi,

Metacam is a ONCE PER DAY drug. If you can give me your rabbit's weight and the concentration of the drug, I can confirm your dosing. Like any drug, it takes time to reach working levels. The first day or so may result in whatappearsto be thedrug wearing off...and it is. But over a period of a couple of days, it will reach and maintain that workinglevel....so if you overdose to compensate....that can lead to excessive levels in the body over time....and that can damage the liver and/or kidneys. I am not so sure that Metacam is the best choice of drug for this situation as kidney issues usually result in some degree of dehydration and NSAIDs are contraindicated in most situations with dehydration. There are other analgesics that might would be a better choice. It is also likely that Baytril will not be up to the task....as is so often the case with that drug. I am going to assume that your vet prescribed that drug until a proper diagnosis can be performed and a more targeted drug implemented. Supplemental fluids are always good with kidney issues. I normally use Sodium Chloride in lieu of LRS in urinary treatments.

Randy
 
Are they doing a culture on the urine to determine which antibiotic is best? It is possible that you've just been given Baytril for until that culture and sensitivity test comes back.

I agree that hydration is a big deal for him, and it may be good to do x-rays while he's under GA for the tooth trim. You can syringe or offer unsweetened pedialyte to increase hydration. You can also add a tiny bit of vanilla flavoring or apple juice to his water to encourage him to drink more.

Fuzz is a cutie! I hope he can get through this ok. Best of luck.
 
ra7751 wrote:
Hi,

Metacam is a ONCE PER DAY drug. 

I am not so sure that Metacam is the best choice of drug for this situation as kidney issues usually result in some degree of dehydration and NSAIDs are contraindicated in most situations with dehydration.  There are other analgesics that might would be a better choice. 
Click to expand...

I disagree (sort of) and agree. I'm going to check into a third opinion.

My vet has said the dosage prescribed is a 24 hour MAXIMUM but it can be split in half and given every 12 hours (although he prescribes a 'kick off' double dose). This has worked better for my rabbits than the 24 hour full dose.

I agree about the use of Metacam in this case being questionable. I do believe NSAIDS or Metacam or both restrict the blood flow to the kidneys and MUST MUST MUST be given to a very well hydrated bunny, and it MUST be given with food (it can also cause ulcers).

When Pipp first had Metacam I wasn't aware of the dehydration issue and sure enough, she was straining to pee after a few doses. Hydration fixed that pretty quick, but I still hope it didn't cause underlying damage.

If this is stones and not an infection, I question whether Metacam is the best drug, too, but I do know in any case he's going to need ongoing subcutaneous injections or infusions of fluids.

And pain relief.

Hope Fuzz is okay. And I'm not sure why they'd be worried about the molar spurs, I'd get the urinary diagnosis first.

ETA: Agree with Tonyshuman about doing the spurs while under anesthetic for x-rays, especially if they're using a sedative and not gas, and if they can do it quickly and efficiently.


sas :pray:
 
Pipp wrote:
ra7751 wrote:
Hi,

Metacam is a ONCE PER DAY drug.

I am not so sure that Metacam is the best choice of drug for this situation as kidney issues usually result in some degree of dehydration and NSAIDs are contraindicated in most situations with dehydration. There are other analgesics that might would be a better choice.
Click to expand...

I disagree (sort of) and agree. I'm going to check into a third opinion.

My vet has said the dosage prescribed is a 24 hour MAXIMUM but it can be split in half and given every 12 hours (although he prescribes a 'kick off' double dose). This has worked better for my rabbits than the 24 hour full dose.

I agree about the use of Metacam in this case being questionable. I do believe NSAIDS or Metacam or both restrict the blood flow to the kidneys and MUST MUST MUST be given to a very well hydrated bunny, and it MUST be given with food (it can also cause ulcers).

When Pipp first had Metacam I wasn't aware of the dehydration issue and sure enough, she was straining to pee after a few doses. Hydration fixed that pretty quick, but I still hope it didn't cause underlying damage.

If this is stones and not an infection, I question whether Metacam is the best drug, too, but I do know in any case he's going to need ongoing subcutaneous injections or infusions of fluids.

And pain relief.

Hope Fuzz is okay. And I'm not sure why they'd be worried about the molar spurs, I'd get the urinary diagnosis first.

ETA: Agree with Tonyshuman about doing the spurs while under anesthetic for x-rays, especially if they're using a sedative and not gas, and if they can do it quickly and efficiently.


sas :pray:
Click to expand...
Too be honest I don't understand the once per daymetacam if the dose is split???
 
The stuff I have is every 24 hrs. However, I think the half-life of the drug is such that it can wear off if it's given every 24 hours, so some split a dose. This will decrease the maximum analgesic effect--ie it won't be able to deal with as large an amount of pain. But, if the rabbit doesn't need a large amount of pain relief but is very sensitive to having no pain relief--ie that it doesn't have a ton of pain but when there's no relief of the pain it feels terrible--it may be good to split the dose. I don't have any practical experience with this though.
 
I hope your Fuzz is ok. I just lost my 12 year old Baby. I thought also felt my girl would be here for a lot longer.


PamsWarren wrote:
Fingers crossed for my old guy :pray:. He is 11.5-12...but if it is true as they say that only the good die young, I almost expected Fuzz to live for ever :D (Just kidding about that last part...Fuzz is a lovely sweet boy.
Click to expand...
 
Thanks for the replies. Fuzz is MUCH improved this morn. He is eating on his own (I am also syringe feeding, which he now willingly takes), drinking, grooming, hopping around, peeing, pooping (lots, but they are still small) and just being, well, Fuzz. :)

I will talk to my vet today about pain control other than Metacam. I understand that Metacam is hard on the kidneys, but until I can speak to the vet about possibly prescribing something else, I will not deny Fuzz pain control. Having said that, years ago, I had an elder rabbit on this drug for a long period without any ill effects (and not getting regular fluids). Fuzz is still getting 75-100 ml of fluids 2x per day, and I will continue to administer fluids as long as he is on this drug. Fuzz is a chronic molar spur bunny, so he does sometimes get Metacam (when his teeth are bothering him, 3-4 times per year), but only for a few days at a time. He usually only needs pain control before the procedure...I rarely have to administer after the spurs are removed.

I know with my dog and Metacam, the first dose was a double dose, then after that, we administered regular dose 1x per day (instructions per our vet). I've never had this drug prescribed this way for a rabbit, though. Something to ask my vet about.

<<I would guess that he has an bladder infection and that the vet decided to hold off on the x-rays hoping the present treatment would take care of the problem...

http://www.rabbitsonline.net/view_topic.php?id=12052&forum_id=10 >>

I think you are right. Thanks for this link, BTW. It was very helpful.

I know Fuzz VERY well. Looking back at the sequence of events, my best guess would be that Fuzz's molar spurs have been bothering him for longer than I thought. Spurs caused him to eat/drink less, which led to dehydration and a UTI. (Not to make excuses for myself, but I just had surgery, so i was in the hospital for a week then pretty much incoherent for a week...I think I missed the fact that his eating had slowed down). I've had good success treating UTI with baytril in other rabbits...hopefully, it will also be appropriate for Fuzz.

I do want to get Fuzz's teeth taken care of as soon as possible. Hoping to do this (and xrays and urinanalysis) today, but I don't know if my regular vet will be in...and given Fuzz's age, I don't want the vet on duty to do his teeth unless they are comfortable anaesthetizing an old rabbit. My other dilemma is, the vet at the clinic where I prefer to have Fuzz's teeth done is on vacation until Thursday. At this clinic they do the teeth and send him home as soon as he is up and coherent. The clinic that I took Fuzz to on Saturday will keep him for the day and I really hate leaving him at the clinic all day. :?
 
Metacam is a once a day drug due to the way it's absorbed and maintained in the body. Most vets give the "double" (called a "loading") dose to get the levels up quickly and follow up with standard dosing. Most vets also don't use Metacam past 3-4 days without additional observations. Baytril is a once a day drug.I dose Pen G once a day for three days and then every otherday....again due to the way the drugs are absorbed.

In reality, the small amount of Metacam used in rabbits probably doesn't matter if you split the dosing....but since most rabbits don't like taking meds....is it worth the additional stress? And for those of you with larger rabbits and have the ability to do injections....there is an injectable version of Metacam available but it is much more concentrated than the oral version. The oral version comes in .5mg/ml and 1.5mg/ml...the injectable is 5mg/ml. I will stick to the once a day dosing.

Randy
 
<<Most vets also don't use Metacam past 3-4 days without additional observations. Baytril is a once a day drug.I dose Pen G once a day for three days and then every otherday....again due to the way the drugs are absorbed.>>

I guess all vets are different. I have often been given baytril to be administered 2x per day at doses as high as 20mg/kg, pen-g or bicillin 1x per day for several months (for a tough abscess) and Metacam for long term pain management.

The stress of administering the additional meds has not been an issue at all...Fuzz sucks the Metacam out of the sryinge like it is candy. He also takes the strawberry flavoured baytril without any problems.
 
I'm so happy to wake up and hear that Fuzz is doing great.
I've also given Metacam to a couple of bunnies and never had a problem with them accepting it.

I would recommend putting Fuzz on Tramadol for pain as well as the Metacam. Thats what I had my Girl Monsters on for her last few Months of her life and I think it made a HUGE differnce in how she was feeling.

:pray: Sending healing vibes to Fuzz and his teeth.


PamsWarren wrote:
.Fuzz sucks the Metacam out of the sryinge like it is candy.
Click to expand...
 
ra7751 wrote:
Metacam is a once a day drug due to the way it's absorbed and maintained in the body. Most vets give the "double" (called a "loading") dose to get the levels up quickly and follow up with standard dosing. Most vets also don't use Metacam past 3-4 days without additional observations. Baytril is a once a day drug.I dose Pen G once a day for three days and then every otherday....again due to the way the drugs are absorbed.

In reality, the small amount of Metacam used in rabbits probably doesn't matter if you split the dosing....but since most rabbits don't like taking meds....is it worth the additional stress? And for those of you with larger rabbits and have the ability to do injections....there is an injectable version of Metacam available but it is much more concentrated than the oral version. The oral version comes in .5mg/ml and 1.5mg/ml...the injectable is 5mg/ml. I will stick to the once a day dosing.

Randy
Click to expand...
Good to know. This means that the half-life of Metacam is quite long. Therefore, dividing the dose won't really do much. By doing that, you're not allowing it to reach a high concentration in the blood and provide optimal pain relief.

It does sound like Fuzz is getting a good amount of water now.

Metacam's a pretty commonly given drug to rabbits, but of course hydration is important. It is sometimes contra-indicated in kidney disease-related pain, because as a NSAID, it has several effects that lead to decreased blood flow to the kidneys, and cause renal impairment--not good if kidney infection/stones are suspected.

Other drugs like tramadol and buprenorphine provide stronger pain relief and not as much stress on the kidneys, but they are narcotics. However, buprenorphine is an opiod and tramadol has some opiod receptor activity, so they can cause gut slowdown, so they're not as commonly given for rabbits. Of these, buprenorphine is probably the safest for animals with renal impairment, as it is metabolized completely by the liver. Tramadol is metabolized by the liver as well, but its metabolites are active and are then excreted by the kidneys, so it's not as bad as NSAIDs when kidneys are impaired, but it's worse than buprenorphine.
 
Another update on Fuzz - XRays were normal...no stones or sludge or other abnormalities. Vet has not yet been able to get a urine sample, as Fuzz is incontinent, so his bladder has not been large enough to obtain a sample. She did confirm the presence of blood in the urine.

Blood work shows low WBC, low RBC, high MCHC (not sure what that is?), low Urea, and low ALP. If anyone knows of anything that can be given to rabbits for anemia, please let me know.

We're hoping for a UTI, but at this point, we're still not sure. She also mentioned cancer.

Any thoughts on the above (especially the blood work) would be appreciated.

The vet really wants to get Fuzz's urinary problem under control before tackling his molar issue. She seems quite leary to anaesthetize him (they did the xray without sedation...Fuzz is a very good, co-operative bunny). I don't want to push her to do something that she is not comfortable doing...but I do not think that Fuzz will really improve until his teeth are dealt with. Not sure what to do about this. I would prefer to have the vet who usually does Fuzz's teeth do the molar grind...but I am not sure that it is proper "vet etiquette" to have two vets working on Fuzz at the same time.

Oh, vet would also like to see Fuzz put on some weight. His weight has been pretty much constant throughout his 12 years and is NOT due to his teeth (his chronic molar issues really just started in the last year), but he is pretty much just fur and bones. He's always been a grazer who eats to live, rather than lives to eat, but any suggestions for weight gain food would be great. I do offer alfalfa some times, but Muffy's FAR more crazy about the alfalfa than Fuzz is....and it gives her poopy butt.
 
MCHC is mean corpuscular hemoglobin concentration. Basically, it's part of figuring out what kind of anemia is present. The low RBC count tells you that she's anemic. However, MCHC measures the amount of hemoglobin in a given volume of blood.

This says that it can be from a vitamin b12 deficiency, or cells with too much hemoglobin in them (in humans): http://www.medfriendly.com/meancorpuscularhemoglobinc.html

But this says that it's impossible to get a high reading for MCHC in veterinary diagnostics: http://diaglab.vet.cornell.edu/clinpath/modules/hemogram/mchc.htm

It also says that lipemia (aka hyperlipidemia, too much fat in the blood) and hemolysis (red blood cells breaking apart) can lead to elevated MCHC levels. Is it possible that Fuzz has fatty liver disease, or is eating a lot of fat?

I do not think that Fuzz has low iron anemia due to the high MCHC.

This page is an interactive guide to the hematogram values: http://diaglab.vet.cornell.edu/clinpath/modules/hemogram/cbc.htm I don't have any experience with abnormal values, but I know a bit about physiology and biochemistry.

Low urea would mean that things are getting out of the kidney ok, so it's working. http://www.mayoclinic.com/health/blood-urea-nitrogen/MY00373

Low ALP is good, I think, since it means the liver is working properly: http://www.labtestsonline.org/understanding/analytes/alp/test.html

Low RBC could be due to bleeding or inflammation, or hemolytic anemia (where the blood cells die early). http://www.labtestsonline.org/understanding/analytes/rbc/test.html

Low WBC points away from an infection. WBC is usually elevated with an infection, or inflammation. Low WBC usually means there's a problem with the immune system, such as bone marrow depletion... http://www.labtestsonline.org/understanding/analytes/wbc/test.html

I agree that at this point it's not good to anesthetize Fuzz. I know you want his teeth to feel better, but those blood values indicate that something is probably off with his elimination system, which can make dosing anesthetics very difficult.

I would hope that it's a bladder infection with bleeding. I don't know what would cause the low WBC in that situation, but it makes sense with the low RBC and low urea. I think a Vitamin B12 shot may be helpful, but I'd wait to see what Randy says about these blood test values. My comments are based only on my knowledge of biochem/physiology, and not anything written in a vet manual or personal treatment experience.
 
Thanks, Tonyshuman...your information is very helpful. I haven't had a chance to look at the links yet, but I will at my earliest opportunity.

<<It also says that lipemia (aka hyperlipidemia, too much fat in the blood) and
hemolysis (red blood cells breaking apart) can lead to elevated MCHC levels. Is it possible that Fuzz has fatty liver disease, or is eating a lot of fat?>>

Per the blood results, lipemia is normal..hemolysis is 1+. I assume this is normal, as it is not noted to be high or low. If Fuzz had fatty liver disease or was consuming alot of fat (I don't think that he is), would the lipemia not be off?

I just had another look at the lab report...hematocrit is also slightly low if that helps at all.

I will definitely ask the vet about a vitamin b-12 shot.

I forgot to note earlier that Fuzz's incontinence seems to be worse since Saturday, but I wonder if that is because he's fully hydrated now, so there is more urine?




 
Ok, if lipemia is normal, that means that it's probably not hyperlipidemia causing the high MCHC levels. Also, assuming hemolysis is normal, and hematocrit is low, that would lead me to think that the blood cells aren't breaking apart. If they were, I think hematocrit would be high. So, that leaves a Vitamin B12 deficiency.

I know there's a vitamin shot called B-Complex Plus that Randy has recommended before, and it's for veterinary use. It has several B vitamins, including B-12. I don't have experience with it, personally.

However, I'd be interested to see if Randy thinks these blood test values indicate anemia caused by B-12 deficiency, or some other thing.

healing thoughts~~
 
ra7751 wrote:
In reality, the small amount of Metacam used in rabbits probably doesn't matter if you split the dosing....but since most rabbits don't like taking meds....is it worth the additional stress?  And for those of you with larger rabbits and have the ability to do injections....there is an injectable version of Metacam available but it is much more concentrated than the oral version. 
Click to expand...

LOL! I had to laugh at this, Pipp, like Fuzz, just LOVES the stuff. She thinks Metacam is the next best thing to oats, and that's mighty huge in her world. She chases me around the room for it.

Hope they get to the bottom of the problem. Great info in this thread, thanks everyone.


sas :pray:
 
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